Basic Information
| Provider Information | |||||||||
| NPI: | 1588996466 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MATT WOOD CHIROPRACTIC, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6033 SOUTH FASHION POINTE DRIVE | ||||||||
| Address2: | # 120 | ||||||||
| City: | SOUTH OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014756800 | ||||||||
| FaxNumber: | 8014756802 | ||||||||
| Practice Location | |||||||||
| Address1: | 6033 SOUTH FASHION POINTE DRIVE | ||||||||
| Address2: | # 120 | ||||||||
| City: | SOUTH OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014756800 | ||||||||
| FaxNumber: | 8014756802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2010 | ||||||||
| LastUpdateDate: | 03/22/2010 | ||||||||
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| AuthorizedOfficialLastName: | WOOD | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | PAUL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8014506940 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 7460477-1202 | UT | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.